Individual provider Active NPI

Dianna Sholomon, MD

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1063830370
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
290069-1 Issued in NY
Practice address
1379 54TH St
Brooklyn, NY 11219-4259
Phone
(718) 436-1600
Fax
(718) 436-2085
NPI assigned
Apr 3, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 290069-1 NY Primary

Addresses

Primary practice location

1379 54TH St
Brooklyn, NY 11219-4259

Mailing address

1379 54TH St
Brooklyn, NY 11219-4259
Phone (718) 436-1600

Other identifiers 1

IdentifierTypeStateIssuer
02559608MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171127000759 NY Practitioner - Internal Medicine 1850658063 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boro Park Medical PCGroup PAC ID 5395642714, 5 clinicians

Practice addresses (Care Compare)

1379 54TH St
Brooklyn, NY 11219-4259
Phone (718) 436-1600

Merit-based Incentive Payment System (MIPS)

Final score
91.39 of 100Reported as apm
Quality
73.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
290069-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Medical Center Current Accepting new patients
Boro Park Medical P.C. Single Specialty CurrentSince Sep 1, 2017 Accepting new patients
Kings Medical PC Single Specialty PastSince Mar 16, 2007 Accepting new patients
First Class Physical Therapy, P.C. Single Specialty Past Accepting new patients

Locations

1379 54th St
Ste 1
Brooklyn, NY 11219
Phone (718) 436-1600

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: diannasholomon@mai.allscriptsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1063830370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1379 54TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112194259",
            "telephone_number": "718-436-1600",
            "fax_number": "718-436-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1379 54TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112194259",
            "telephone_number": "718-436-1600",
            "fax_number": "718-436-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOLOMON",
        "first_name": "DIANNA",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "290069-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02559608",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.